Even for girls in U.S., female genital mutilation and 'vacation cutting' are risks

Elizabeth Ralyea, who was born in Burkina Faso and now lives in Chicago, underwent female genital mutilation when she was a girl. Now 48, Ralyea refused to have her daughter cut and tries to stop others from continuing the practice. (Nancy Stone / Chicago Tribune)

Elizabeth Ralyea, who was born in Burkina Faso and now lives in Chicago, underwent female genital mutilation when she was a girl. Now 48, Ralyea refused to have her daughter cut and tries to stop others from continuing the practice. (Nancy Stone / Chicago Tribune)

Elizabeth Ralyea remembers people holding her arms and legs while she screamed and kicked at the woman who approached with a razor blade.

She thinks she was about 6, or maybe 8, and she was living with her family in the West African country of Burkina Faso.

The elder woman began to cut between Ralyea's legs, she recalled. When she yelled at the woman, her mother grabbed a branch to swat her for being impolite, she said.

"It's a lot of pain," recalls Ralyea, now 48. "It's still just like yesterday."

Ralyea, a nurse practioner who lives in Humboldt Park, is one of the estimated tens of thousands of women in Illinois who have undergone or are at risk for what the U.S. Centers for Disease Control and Prevention calls female genital cutting or mutilation, the removing of all or parts of a girl's genitals.

The April arrests of three people in Michigan, including two doctors accused of coordinating and performing the procedure on girls about 6 to 8 years old, has shed new light on a ritual shrouded in secrecy. Women in Chicago say it has spurred conversations about a tradition in many African, Middle Eastern and South Asian countries that had often been kept in the shadows.

Nancy Stone / Chicago Tribune

Elizabeth Ralyea, photographed in Humboldt Park in Chicago on June 5, 2017, grew up in Burkina Faso in West Africa where she underwent female genital cutting as a very young girl. Ralyea, a nurse, is now outspoken against the practice.

Elizabeth Ralyea, photographed in Humboldt Park in Chicago on June 5, 2017, grew up in Burkina Faso in West Africa where she underwent female genital cutting as a very young girl. Ralyea, a nurse, is now outspoken against the practice.

(Nancy Stone / Chicago Tribune)

"It's happening, but no one talks about it," said Ralyea, who arrived in Chicago from Burkina Faso in 1990 when she was 21.

In Illinois, there are about 10,000 to 25,000 women and girls who have been cut or are at risk of being cut, according to the Washington-based Population Reference Bureau. Nationwide, 513,000 women and girls born into families who practice the tradition or who immigrated from those countries were at risk of female genital mutilation in 2012, more than double the number in 2000, according to the CDC, a rise attributed to an increase in immigration from countries where the practice is prevalent.

Women in Chicago said the tradition is a familiar one. They have friends who were cut as girls or friends who are considering the procedure for their own daughters.

One Chicago woman who is a member of the small Muslim sect Dawoodi Bohra — of which the Michigan doctors are also members — said she was asked recently by another mother if she was considering what she called circumcision for her daughter.

"I was appalled," said the woman, who asked that her name not be used because she did not want to receive criticism from her community for speaking out against a practice she said remains common within their sect. "I have a 7-year-old daughter. I would obviously tell her these things are assault in any other context."

The procedure has been illegal to perform in the U.S. since 1996, and it is outlawed in African countries including Guinea-Bissau and Burkina Faso. Still, according to a 2016 report from the Population Reference Bureau, "it remains a significant harmful tradition for millions of girl and women."

After the Michigan arrests, an organization overseeing the Dawoodi Bohra community in Detroit released a statement saying it does not condone violating U.S. law.

States have considered implementing measures of their own. Last month, Minnesota's House approved a measure that would create new penalties for doctors. Legislation approved by the Michigan Senate would make genital mutilation punishable by up to 15 years in prison.

The FBI created a tip line following the arrests in Michigan, requesting information on anyone suspected of assisting, facilitating or performing female genital mutilation. Earlier this year, after a 2016 Government Accountability Office report said federal awareness efforts should be improved, the Department of Homeland Security outlined a strategy to reach girls at risk of being cut, including brochures and tip lines.

Social worker Joanna Vergoth runs a Chicago-based group called Forma that supports women who have experienced genital cutting, which the World Health Organization considers a human rights violation. Her group provides individual and group counseling, and offers seminars to raise awareness of the dangers of the practice.

For most U.S. women and girls who have been cut, the procedure was performed in their home country before moving here, Vergoth said, or while they were sent abroad — often called "vacation cutting."

In 2013 it became illegal in the U.S. to knowingly transport a girl out of the country for cutting.

Ralyea said she has Chicago friends from countries like Burkina Faso and Mali who are nervous that if they send daughters back for a summer visit with relatives, a family member might allow the girls to be cut as a "favor," because it's considered a ritual and a milestone.

Female genital mutilation is an umbrella term used to describe various degrees of scraping or cutting female sexual organs, said Dr. Lori Post, a professor in emergency medicine at Northwestern University's Feinberg School of Medicine who has researched female genital mutilation for decades.

The least invasive type involves removing all or part of the clitoris, said Post, who co-authored a column outlining the dangers and the wide spectrum of procedures for an upcoming issue of Lancet.

The most extreme procedure, which Post said also is the most common, removes the entire clitoris and labia, and stitches the vagina shut. A small hole remains to urinate and menstruate. In some cultures the woman's vagina is cut open again on her wedding night by their husband.

Post noted the practice happens in many countries for different reasons. Typically, it is considered necessary for girls to remain virgins until marriage and to control their sexual drives, Post said. The procedure is usually performed on girls ranging from infants to 7 years old.

Whatever the type, Post emphasized, girls are subjected to pain. The cutting is often done without proper anesthesia and with crude instruments.

"The mutilation tools are god awful," she said. "It could be anything from broken Pepsi bottles to razor blades, if you're lucky."

Chicago doctors said they sometimes see evidence of a woman who has been cut, and some patients have asked to be sewn back up after delivering a baby.

For Ralyea's family, genital cutting was viewed as a rite of passage. Her four older sisters had undergone genital mutilation before she did, she said.

Ralyea recalls being lined up with other girls around the same age. After they were held down and cut, she said, they sat in holes in the ground, and dirt was packed around their groins to soak up the blood.

After a few weeks, when they had healed, they were feted. People danced. Many girls got a new dress or special hairdo — and exuberant attention.

"It's just a celebration," said Ralyea, whose own daughter is now 27 and has never been cut. Ralyea is in the support group Vergoth runs for women who have undergone cutting, and their conversations often turn toward raising awareness and stopping others from doing this.

When friends give birth to daughters, whether in Chicago or back home in Burkina Faso, Ralyea said she calls to say: "Make sure this doesn't happen to this girl."